Two-mode ecg monitoring system

ABSTRACT

THE MONOTORING AND ANALYSIS OF ELECTROCADIOGRAPHIC SIGNALS, IN THE CORONARY CARE UNIT, TO IDENTIFY ARRHYTHMIAS, AND THE LIKE, REQUIRES THE IMMEDIATE DETERMINATION OF CATASTROPHIC EVENT INFORMATION AND THE SUBSEQUENT DETERMINATION OF TREND INFORMATION. TO ACHIEVE THIS END, A GENERAL PURPOSE DIGITAL COMPUTER IS SHOWN GENERALLY WITHIN BLOCK 1 OPERATED TO CONTINUOUSLY MONITOR, REAL TIME, SELECTED ECG DATA AND PROVIDE AN ALARM UPON THE OCCURRENCE OF A CATASTROPHIC EVENT. IN ADDITION, THE COMPUTER IS OPERATED AS REPRESENTED BY SWITCH 27 AND CONTROL BLOCK 29 TO INTERMITTENTLY STORE, REAL TIME, FIXED INTERVALS OF THE SELECTED ECG DATA. AFTER EACH FIXED INTERVALS OF SELECTED ECG DATA IS STORED IN DISK STORE 23, FOR EXAMPLE, THE COMPUTER IS OPERATED TO ANALYZE FOR ECG EVENTS INDICATIVE OF CARDIAC TRENDS. DURING THIS TREND ANALYSIS OPERATION NO SELECTED ECG DATA IS STORED BUT THE COMPUTER IS STILL UNDERGOING THE CATASTROPHIC EVENT ANALYSIS OPERATION. AFTER EACH TREND ANALYSIS OPERATION, ANOTHER FIXED INTERVAL OF SELECTED ECG DATA IS STORED. DURING EACH STORAGE OPERATION, BACKGROUND OPERATIONS MAY BE PREFORMED, IN ADDITION TO THE CATASTROPHIC EVENT ANALYSIS OPERATION.   D R A W I N G

DEFENSIVE PUBLICATION UNITED STATES PATENT OFFICE Published at the request of the applicant or owner in accordance with the Notice of Dec. 16, 1969, 869 0.6. 687. The abstracts 01 Defensive Publication applications are identified by distinctly numbered series and are arranged chronologically. The heading of each abstract indicates the number of pages of specification, including claims and sheets of drawings contained in the application as originally filed. The flies of these applications are available to the public for inspection and reproduction may be purchased for 30 cents a sheet.

Defensive Publication applications have not been examined as to the merits of alleged invention. The Patent Oflice makes no assertion as to the novelty of the disclosed subject matter.

PUBLISHED NOVEMBER 27, 1973 T916 007 TWO-MODE ECG MONITORING SYSTEM Raymond E. Bonner, Yorktown Heights, N.J., assignor to International Business Machines Corporation, Armonk, m

9i Continuation of abandoned application Ser. No. 135,681 GWEN R R NTERVAL mm Apr. 20, 1911. This application Apr. 3, 1913, Ser. No: BUFFER BY 25%? 347,522 as NOL+,

Int. Cl. G06f 15/42, 9/18 2. 5 sheets i ing sfmcificafion CENTER WENCKEBABH PHENOHENUN ROUTINE) The monitoring and analysis of electrocardiographic l signals, in the coronary care unit, to identify arrhythmias, and the like, requires the immediate determination of IS R-R INTERVAL PRIOR T0 THIS /95 catastrophic event information and the subsequent dc- H INTERVAL SMALLER THAI termination of trend information. To achieve this end, a AVERAGE BUFFER general purpose digital computer is shown generally with- YES NO in block 1 operated to continuously monitor, real time, selected ECG data. and provide an alarm upon the occur- |5 Mm m COMPLEX m A ar rence of a catastrophic event. In addition, the computer norm vmmcurin coupler is operated as represented by switch 27 and control block 29 to intermittently store, real time, fixed intervals of the selected ECG data. After each fixed interval of selected ECG data is stored in disk store 23, for example, the

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IS THERE A norm P WAVE errors run ens comm YES computer is operated to analyze for ECG events indicam tive of cardiac trends. During this trend analysis operation no selected ECG data is stored but the computer is fsifi NOL. still undergoing the catastrophic event analysis operation.

After each trend analysis operation, another fixed inter- 15 THE H m m A val of selected ECG data is stored. During each storage T LEAST 4 mmsgc s operation, background operations may be performed, in LONGER nun m1 OF R"? addition to the catastrophic event analysis operation.

YES

is THERE A NORMAL F WAVE. HALF-WAY BETWEEN THE NQRHAL P WAVE ASSOCIATED WITH THE GIVEN R's? Nov. 27, 1973 R. E. BONNER TWO-MODE ECG MONITORING SYSTEM 5 Sheets-Sheet 1 Original Filed April 20 1971 21K 2523 E 22:52 3: s2 552: w E52 z W O a 252; a; i l fif E: 22:5 252553 :0: is 22: 2:52:23 2 22:5 a\ 3:2: 2:: W K 222;; 2:22 5: iii]. 252550 N 2 E5128 2: w 5 W wwonEi 25.2mm v n W r EEw zou .1 055mm 35: Q :11. $63.53: 56 0k @332 1 i i n I \1|\ w E m ATTORNEY NOV. 27, 1973 BONNER T916,007

TWO'MODE ECG MONITORING SYSTEM Original Filed April 20, 1971 5 Sheets-Sheet z FIG. 28 M/ 450MS 1 /FLUTTER WAVES FIG. 2c

FIG. 20

Nov. 27, 1973 R. E. BONNER T916,007

TING-MODE ECG MONITORING SYSTEM Original Filed April 20 1971 FIG.3

FIG. 3A

FIG. 3B

5 Sheets-Sheet I LSET PRESENT POINT T0 FIRST POINT CONSIDER PRESENT POINT FROM POINT SELECTOR 57 59 IS ALARM BEING GIVEN? T YES NO J FORTHIS PATIENT? I 4? IS PT. AMI? OUTSIDE RANGE YES NO ESTABLISHED SO FAR no [49 YES E J IS ITNEAR RESET END END OF RANGE? OF RANGE N0 ms SHUT OFF ALARM W5 I RESETASYSTOLE 453 sum rmE HAS START or POSSIBLE ASYSTOLE 55 PERIOD BEEN ESTABLISHED YET YES no HAS 3SEC. OR MORE ELAPSED SINCE THE sum WITHOUT (5? ACCEPTABLE SEGMENT? m YES NO 'I am ALARM! I IS PRESENT POINT PICIIED BY man SLOPE THRESHOLD? Iuo IYEs K65 IS THE AMPLITUDE FROM THIS PT T0 LAST HIGH SLOPE PT GREATER THAN .3mv

NO YES Nov. 27, 1973 R. E. BONNER TWO-MODE ECG MONITORING SYSTEM Original Filed April 20, 1971 5 Sheets-Sheet 4 NOT VALID SEGMENT-BREAK PRESENT SEGMENT STRING INITIALIZE PARAMETERS TO START NEW STRING WITH PRESENT SEGMENT.

STORE TIME OF LAST ENTRY IN STRING.

[TIT] START CHECK FOR VENTRICULAR TAOIIYCAROIA 65\ IS TIME FROM LAST SUCH sEGNENT GREATER THAN 200ms? INo YES IS sEGNENT WIDTH LARGER THAN 40 ms? GT v JNO YES ACCEPTABLE sEGNENT \B REsET ASYSTOLE START TIME sToRE TIME AND AMPLITUDE 0F \69 PRESENT POINTAS IS TIME TO LAST sEGNENT 75 NEW LAST POINT GREATER THAN 450ms? I YES NO \VALID SEGMENT I I I ENTER MATCH ROUTINE P 77 DOES DURATION MATCH WITHIN 25 ms YES INO IS SLOPE THE SAME SENSE YES ADO ONE TO STRING COUNT IS TEN OR MORE? YES GIVE ALARM! NOV. 27, 1973 R E BONNER T916,007

'I'WO MODE ECG MONITORING SYSTEM Original Filed April 20, 1971 5 Sheets-Sheet 5 R AND 0R5 COMPLEX DATA' IS GIVEN RR INTERVAL LONGER THAN AVERAGE IN BUFFER BY MORE THAN 25%? YESLkmmw N0 I m rr 1 ENTER VIENCKEBACH PRENONENON ROOTTND IS R-R INTERVAL PRIOR TO THIS 95 R-R INTERVAL SMALLER THAN AVERAGE INTERVAL IN BUFFER TESI E .&\L NO IR L IS PRIOR ORs COMPLEX IR) A NORMAL VENTRICULAR COMPLEX RENE} NOI- L .,L

IS THERE A NORNRL P WAVE BEFORE EACH ORs COMPLEX RAND R" YEsIx NOI IS THE P-R INTERVAL FOR R AT LEAST 40 MILLISECONDS LONOER THAN TNRT OF R" IVENCKEBACH PRENONENON A05 I EXIT 

